HCPCS Service Codes - ESRD supplies

HCPCS Service Code L for ESRD supplies.

HCPCS Type of Service (TOS) code is an indicator that the contractor places on Form CMS-1500. The indicator is mainly used for data purposes, however in some instances, it affects payment. All HCPCS codes have a corresponding TOS indicator.

Below are all available HCPCS TOS codes. Find an HCPCS code based on the type of service.

HCPCS Codes for ESRD supplies

  • A4215

    Needle, sterile, any size, each

  • A4244

    Alcohol or peroxide, per pint

  • A4245

    Alcohol wipes, per box

  • A4246

    Betadine or phisohex solution, per pint

  • A4247

    Betadine or iodine swabs/wipes, per box

  • A4248

    Chlorhexidine containing antiseptic, 1 ml

  • A4450

    Tape, non-waterproof, per 18 square inches

  • A4452

    Tape, waterproof, per 18 square inches

  • A4651

    Calibrated microcapillary tube, each

  • A4652

    Microcapillary tube sealant

  • A4653

    Peritoneal dialysis catheter anchoring device, belt, each

  • A4657

    Syringe, with or without needle, each

  • A4660

    Sphygmomanometer/blood pressure apparatus with cuff and stethoscope

  • A4663

    Blood pressure cuff only

  • A4670

    Automatic blood pressure monitor

  • A4671

    Disposable cycler set used with cycler dialysis machine, each

  • A4672

    Drainage extension line, sterile, for dialysis, each

  • A4673

    Extension line with easy lock connectors, used with dialysis

  • A4674

    Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz

  • A4680

    Activated carbon filter for hemodialysis, each

  • A4690

    Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each

  • A4706

    Bicarbonate concentrate, solution, for hemodialysis, per gallon

  • A4707

    Bicarbonate concentrate, powder, for hemodialysis, per packet

  • A4708

    Acetate concentrate solution, for hemodialysis, per gallon

  • A4709

    Acid concentrate, solution, for hemodialysis, per gallon

  • A4714

    Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon

  • A4719

    "y set" tubing for peritoneal dialysis

  • A4720

    Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis

  • A4721

    Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis

  • A4722

    Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis

  • A4723

    Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis

  • A4724

    Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis

  • A4725

    Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis

  • A4726

    Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis

  • A4728

    Dialysate solution, non-dextrose containing, 500 ml

  • A4730

    Fistula cannulation set for hemodialysis, each

  • A4736

    Topical anesthetic, for dialysis, per gram

  • A4737

    Injectable anesthetic, for dialysis, per 10 ml

  • A4740

    Shunt accessory, for hemodialysis, any type, each

  • A4750

    Blood tubing, arterial or venous, for hemodialysis, each

  • A4755

    Blood tubing, arterial and venous combined, for hemodialysis, each

  • A4760

    Dialysate solution test kit, for peritoneal dialysis, any type, each

  • A4765

    Dialysate concentrate, powder, additive for peritoneal dialysis, per packet

  • A4766

    Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml

  • A4770

    Blood collection tube, vacuum, for dialysis, per 50

  • A4771

    Serum clotting time tube, for dialysis, per 50

  • A4772

    Blood glucose test strips, for dialysis, per 50

  • A4773

    Occult blood test strips, for dialysis, per 50

  • A4774

    Ammonia test strips, for dialysis, per 50

  • A4802

    Protamine sulfate, for hemodialysis, per 50 mg